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November 27, 2023
Margaret G. Parker
Jul 28, 2023
The Future of Population Health
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Experiences during pregnancy and childhood profoundly shape lifelong health and developmental trajectories, forming the uneven foundation for increasingly inequitable adult outcomes.1–5 Although the importance of pregnancy and early childhood as critical periods is well understood, supports to families facing intersecting health and social needs are not well suited to the realities of this stage of life. In this article, we discuss the interplay between health and economic vulnerability during pregnancy and childhood, how these overlapping challenges are addressed by current policies, and discuss the rationale for cash transfers provided in health care settings, including examples of research from ongoing trials.
Maternal, infant, and child morbidity and mortality outcomes in the United States are consistently higher than other high-income countries.6–8 This pattern is driven by higher rates of adverse pregnancy and birth outcomes and worse child health outcomes for Black families and economically disadvantaged families.9–11 These disparities are increasingly understood to result from societal inequities, including structural racism and persistent child poverty not adequately addressed by the social safety net.12–15 Furthermore, adverse health experiences and complex health conditions during pregnancy and childhood put extraordinary pressure on already socioeconomically disadvantaged families, including increased visits to health care settings for monitoring and treatment, the potential for prolonged hospitalizations, and intensive caregiving demands. Meeting these demands can lead to increased economic precarity because of foregone income from missed hourly wages; increased out-of-pocket spending including transportation, parking, and accommodation costs incurred while utilizing health care; and the need to pay for food or childcare for other children. In turn, these economic burdens can make it more challenging for some families to participate actively in their care or the care of their children, contributing to disparities in outcomes.
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The Milbank Quarterly is an editorially independent multidisciplinary journal that offers in-depth assessments of the social, economic, political, historical, legal, and ethical dimensions of health and health care policy.